Fluid Volume Deficit - Nursing Care Plan for Leptospirosis

Nursing Diagnosis and Interventions

Leptospirosis is a zoonotic disease caused by microorganisms, ie Leptospira that regardless of serotype -specific form. This disease can be passed on via the male or female of all ages. Mostly found in the tropics, and usually the disease is also known by various names such as mud fever, slime fever, swamp fever, autumnal fever, infectious jaundice, filed fever, fever cutre cane and others.

Manifestations of leptospirosis infection have a very varied and sometimes asymptomatic. Nearly 15-40 % of patients exposed to infection are asymptomatic but serologically positive. The incubation period of 7-12 days with a range of 2-20 days. Approximately 90% of patients with mild jaundice , severe jaundice 5-10 % is often known as Weil's disease. Leptospires disease course consists of two phases , namely phase and phase immune septicemia. In the period of 1-3 days during the phase transition condition of the patient improved.

1. Initial phase is known as septicemic phase or leptospiremic phase because bacteria can be isolated from blood, cerebrospinal fluid, and most of the body's tissues. Initial phase of approximately 4-7 days, marked nonspecific flu-like symptoms with a few variations. The clinical manifestations of fever, chills, weakness and pain especially the ribs, back and stomach. Other symptoms are sore throat, cough, chest pain, vomiting of blood, rash, frontal headache, photophobia, mental disturbances, and meningitis. Physical examination often get a fever of about 40 0C accompanied by tachycardia. Subconjunctival suffusion, pharyngeal injection, splenomegaly, hepatomegaly, mild jaundice, mild jaundice, muscle weakness, lymphadenopathy and skin manifestations in the form of macular, maculopapular, erythematous, urticaria, or rash was also obtained in the early phase of disease.

2. Second phase is often called the immune phase or leptospiruric phase, because circulating antibodies can be detected by isolation of bacteria from the urine ; may not be obtained again from the blood or cerebrospinal fluid. This phase occurs at 0-30 days due to the response of the body's defense against infection. Symptoms depend the body's organs such as the lining of the brain, heart, eyes or kidneys. Nonspecific symptoms such as fever and muscle aches may be lighter than the initial phase for 3 days to several weeks. Approximately 77 % of patients experienced a continuous headache unresponsive to analgesics. These symptoms are often associated with the early symptoms of meningitis other than delirium. In the more severe phases obtained prolonged mental disorders including depression, anxiety, psychosis and dementia.



Nursing Diagnosis for Leptospirosis : Fluid volume deficit related to lack of fluids and electrolytes active

NOC :

• Fluid balance
• Hydration
• Nutritional Status : Food and Fluid Intake

Outcomes :

• Maintain urine output in accordance with the age and body weight, urine specific gravity normal.
• Blood pressure, pulse, body temperature within normal limits.
• No signs of dehydration, good elasticity of skin turgor , moist mucous membranes, no excessive thirst.

NIC :

• Fluid management
• Measure diapers if needed.
• Maintain a record of intake and output accurately.
• Monitor hydration status ( mucous membrane moisture, adequate pulse, orthostatic blood pressure ) , if necessary.
• Monitor vital signs.
• Monitor the input of food / fluids and calculate daily caloric intake.
• Collaborate IV fluid administration.
• Monitor nutritional status.
• Give IV fluids at room temperature.
• Encourage oral input.
• Provide appropriate replacement nesogatrik output.
• Encourage families to help patients eat.
• Give snack (fruit juice , fresh fruit).
• Collaboration doctor if signs of excess fluid appears to worsen.
• Adjust the possibility of transfusion.
• Preparation for transfusion.